Health IT Gap Between Large, Small Hospitals Widens

Government investment in EHRs might increase the gap in health IT adoption rates between large and small hospitals.

From article on InformationWeek Healthcare for May 16, 2012

The federal government’s incentive programs for the adoption of electronic health records (EHRs) is widening the digital divide between large and small providers. In fact, the 15% gap in EHR adoption between small and large hospitals seen in 2010 has grown to nearly 22% in 2011, according to an online study in Health Affairs.

The report, entitled Small, Nonteaching, And Rural Hospitals Continue To Be Slow In Adopting Electronic Health Record Systems, is the first nationally representative survey of hospital EHR system adoption since the federal incentive programs began. It examined EHR adoption among U.S. hospitals, using data from the American Hospital Association (AHA) annual survey of health information technology.

The report says: “The widening of previously described gaps in adoption of EHR systems based on hospital size, teaching status, location, and region of the country grew substantially, at least in absolute terms.”

The study included previous research on EHR adoption during the period of 2008 to 2011, and received responses from executives at 3,233 hospitals. Through a process of elimination, 2,646 hospitals–58% of all acute care hospitals in the U. S.–were selected for analysis.

The report’s authors also looked at hospitals that have adopted a comprehensive electronic health system and those whose systems met the authors’ proxy criteria for Meaningful Use (MU).

“Congress intended the EHR incentive programs to achieve widespread adoption of EHRs across all hospitals. It was not intended to get the leaders over the line while smaller, nonteaching, and rural hospitals are left behind,” Chantal Worzala, director of policy at the American Hospital Association and co-author of the report, told InformationWeek Healthcare. “The gap between the hospitals that were furthest ahead and those that were furthest behind is something that we really want to make sure folks understand because we think it is potentially problematic.”

Worzala said the research suggests that as providers work to meet MU Stage 2, which requires more clinical reporting and an infrastructure to accommodate the exchange of greater amounts of clinical data, the situation might only get worse.

The fear is that smaller hospitals, which have limited financial resources, fewer IT workers, and an inadequate health IT infrastructure, will not be able to compete with larger hospital systems for the attention of EHR vendors or be able to elicit their assistance to meet Stage 2 criteria.

“We are certainly concerned that this trend may not be closing the gap the way we hoped this EHR program would have achieved,” Worzala said.

The survey, which was fielded in October and December 2011, also found that the number of hospitals with any electronic health record system increased from 15% in 2010 to 26.6% in 2011, and those with a comprehensive system rose from 3.6% to 8.7%.

To assist their research, the authors developed a proxy standard for Meaningful Use based on 12 functions that closely resembled 12 of the 14 core criteria of the first stage of Meaningful Use. The study used less-stringent proxy criteria to see how close healthcare organizations were to meeting the real MU criteria. The 12 proxy criteria were: computerized records for patient demographics; problem lists; medication lists; vital signs; smoking status; patient allergies; computerized provider order entry for medications; decision support, including clinical guidelines; drug-allergy and drug-drug alerts; automatic generation of quality metrics; and provision of electronic discharge summaries and health information to patients.

The authors found that the proportion of hospitals that met their proxy criteria for Meaningful Use rose, with nearly one in five U.S. hospitals (18.4%) having all 12 core functions implemented in at least one unit–a substantial increase from 4.3% in 2010.

However, the study noted that “although the number of hospitals meeting Stage 1 Meaningful Use criteria, using a very relaxed proxy definition, increased substantially, more than 80% of U.S. hospitals still could not do so.”

In the meantime, the authors called for policy makers to redouble their efforts to make sure that their policies do not further widen the gap in health IT adoption rates between large and small hospitals. The authors also made several recommendations including urging regional extension centers to provide assistance with health IT adoption among vulnerable providers. The federal government should also continue to focus its efforts on providing assistance to help with the shortage of trained health information technology professionals.

When it comes to Meaningful Use Stage 2, the authors suggest that policy makers must decide how high to set the bar for smaller, rural, and non-teaching hospitals, especially those that could not meet Meaningful Use Stage 1 criteria in 2011.

For hospitals that have almost no health information technology at all, the report recommends a special program designed to get them on board that will require “resources and skills that go beyond what the current regional extension center program is designed to achieve.”

One suggestion, the authors note, is to involve stakeholders in an effort to help these hospitals adopt health IT. “For example, commercial payers could align their own incentive programs with Meaningful Use standards or educate their members about the benefits of EHR technology to build consumer demand,” the authors said.